I’ve never had kidney dialysis. I do not know anyone who has. I can’t speak to how unpleasant it is. But this tweet got to me. If 20% of people are choosing to end their lives rather than continue with dialysis it’s a system failure. I also do not have end stage Kidney Disease so I can’t speak to the role the disease that leads to dialysis plays. The National Kidney Foundation website says the average life expectancy of a dialysis patient is 5-10 years but some people have lived 20+ years.
I hope there are are ways dialysis could be made more patient friendly. But, as always, an ounce of prevention is worth a pound of cure. The two main causes of kidney disease are diabetes and high blood pressure. If we can prevent and successfully treat those two conditions wouldn’t that result in a lot fewer dialysis patients?
There is both a public responsibility and a personal responsibility in doing that. We have a public responsibility to make sure that health care is accessible and affordable to everyone. In 1972, the U.S. Congress granted coverage under Medicare to anyone diagnosed with kidney failure - link. But it seems people need to have Stage 4 or advanced kidney disease to qualify. I think we should cover people with Stage 3 kidney disease so we can prevent more people from ever needing dialysis or a kidney transplant. That would be a win-win situation both avoiding the most expensive care and improving people’s health outcomes.
Of course, we have a public responsibility to make sure health care is accessible and affordable to all Americans for ALL health conditions. It is estimated 37 million Americans have CKD, but most do not know it because symptoms usually do not appear until the disease is advanced. The CDC also says that 40% of the people were severe kidney disease do not know they have it. Also, high blood pressure is called "the silent killer" because again most people do not have symptoms until they develop complications. Also, one third of adults with diabetes do not know it. Universal health care would do a lot to increase the number of people who get routine check ups and are diagnosed and treated early, when treatment is much less expensive and health outcomes better.
I do not have Chronic Kidney Disease. I just had my yearly check up and my Creatinine — the most common measure of kidney function — is .85. But there were times in my life I was afraid of getting kidney disease. Why? I was presumably born with a small right kidney. It works fine, but just can not do as much. I do not understand it all, but it made me vulnerable to developing high blood pressure as a teenager. At age 16, my blood pressure would be 180/62, a very high systolic reading but good diastolic reading. At age 24, it was 190/100 and I was started on blood pressure medicine which I’ve taken for a few decades. High blood pressure does not run in my family, so it’s a mystery. At around age 26, I had a renal angiogram to rule out renal artery stenosis. The blood circulation into the small kidney is all normal. I currently take both Losartan and Amlodipine which controls it.
I do not have diabetes, but Type 2 diabetes does run in my family. I do have prediabetes. At my recent checkup, my A1C was 5.7%. That just put me in the prediabetes range of 5.7%-6.4%. As I understand it, prediabetes is like a yellow traffic light. The light is not yet “red” and you do not have diabetes, but you need to start working on lifestyle changes before the light turns red. I think I can get the A1C down. I was eating healthy and had reduced my A1C from 6.1% to 5.3% getting out of the prediabetes range, but I got off track with COVID. It’s time to get back on track!
I thought about why people get off track. When something doesn’t come natural to you, it takes a lot of focus and energy to change the habit. When something happens to distract us, and takes up our focus, such as COVID, we suddenly don’t have the bandwidth and get off track. I think one key is to continue the new habit long enough so it becomes natural and you do it without much thought!
As mentioned, there is a public responsibility and a personal responsibility in staying healthy. The public responsibility is ensure health care is available and affordable to all Americans. The personal responsibility is that we each do our best to follow recommended treatment and lifestyle changes!!
I plan to work on doing my part when it comes to my own high blood pressure and prediabetes so that I do not ever get Chronic Kidney Disease.
In terms of treating Stage 3 kidney disease, I think most people are advised to eat a low sodium and low protein diet.
One of the best books I ever read on CKD is by Gail Rae Garwood "What Is It and How Did I Get It? Early Stage Chronic Kidney Disease." The author is not a medical expert, but a patient. She does
a great job telling her personal story. The book makes a reader feel optimistic they can make the lifestyle changes she did and that there is hope.
